Excellent AUC for joint fluid cytology in the detection/exclusion of hip and knee prosthetic joint infection
Language English Country Czech Republic Media print-electronic
Document type Journal Article
PubMed
28529343
DOI
10.5507/bp.2017.021
Knihovny.cz E-resources
- Keywords
- ROC curves, lymphocyte percentage, neutrophil percentage, prosthetic joint infection, synovial white cell count,
- MeSH
- Biomarkers metabolism MeSH
- Prosthesis-Related Infections diagnosis MeSH
- Hip Prosthesis adverse effects microbiology MeSH
- Leukocytes metabolism MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip * adverse effects MeSH
- Neutrophils metabolism MeSH
- Area Under Curve MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Knee Prosthesis adverse effects microbiology MeSH
- Aged MeSH
- Sensitivity and Specificity MeSH
- Synovial Fluid cytology MeSH
- Arthroplasty, Replacement, Knee * adverse effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Biomarkers MeSH
BACKGROUND AND AIM: The aim of this study was to evaluate the characteristics of synovial fluid (SF) white cell count (SWCC) and neutrophil/lymphocyte percentage in the diagnosis of prosthetic joint infection (PJI) for particular threshold values. METHODS AND RESULTS: This was a prospective study of 391 patients in whom SF specimens were collected before total joint replacement revisions. SF was aspirated before joint capsule incision. The PJI diagnosis was based only on non-SF data. Receiver operating characteristic plots were constructed for the SWCC and differential counts of leukocytes in aspirated fluid. Logistic binomic regression was used to distinguish infected and non-infected cases in the combined data. PJI was diagnosed in 78 patients, and aseptic revision in 313 patients. The areas (AUC) under the curve for the SWCC, the neutrophil and lymphocyte percentages were 0.974, 0.962, and 0.951, respectively. The optimal cut-off for PJI was 3,450 cells/μL, 74.6% neutrophils, and 14.6% lymphocytes. Positive likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 19.0, 10.4, and 9.5, respectively. Negative likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 0.06, 0.076, and 0.092, respectively. CONCLUSIONS: Based on AUC, the present study identified cut-off values for the SWCC and differential leukocyte count for the diagnosis of PJI. The likelihood ratio for positive/negative SWCCs can significantly change the pre-test probability of PJI.
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